The Japanese Journal of Clinical Dialysis Vol.29 No.6(5-1)

Theme Medical treatment, nursing care, and life support for patients with advanced CKD stages
Title Life style and nutritional management
Publish Date 2013/06
Author Akihiko Kato Blood Purification Unit, Hamamatsu University School of Medicine
[ Summary ] It is important to advice patients on how to correct their lifestyles. Avoiding high protein intake, low physical activity, smoking and excess alcohol consumption are vital for patients with stage G3 CKD or more advanced conditions. However, when patients are given advice concerning lifestyle modification, individual support is required. For example, when providing guidance on dietary protein restriction, patients must be monitored carefully for clinical and biochemical markers related to nutritional deficiencies. In addition, these restrictions must be avoided for those exhibiting evidence of or at risk of malnutrition. A recent practical clinical guideline concerning Kidney Disease : Improving Global Outcomes (KDIGO) suggests that lowering protein intake to 0.8 g/kg of ideal body weight/day for adults with or without diabetes or stage G4 to G5 CKD may be accomplished with appropriate education. Dietary salt restriction may also be harmful under some conditions including salt losing nephropathies and those prone to hypotension and volume contraction who do not have heart failure. It is reasonable to start physical exercise at moderate intensity levels and increase it gradually, and to avoid vigorous exercise at risk of coronary thrombosis.
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